June 18, 2026

In 2021, the CBO estimated that the No Surprises Act would lower insurer reimbursements to providers, reducing premiums and overall healthcare spending. The agency is now calling for more research amid growing evidence that the law may be having the opposite effect. Recent findings show that hospitals and medical groups win more than eight in ten out-of-network payment disputes and are often awarded amounts well above comparable in-network rates. If providers can secure higher payments through arbitration, they may have less incentive to join insurer networks or accept lower contracted rates, potentially driving up premiums over time.

Marketplace competition is showing signs of strain after years of growth. Compared with 2025, three in ten counties have fewer ACA insurers in 2026, and 165 counties now have only one insurer offering exchange plans, up from 93 last year. The decline marks the first drop in the average number of ACA marketplace insurers since 2018. KFF points to shrinking enrollment as a key factor, following the expiration of enhanced subsidies that had helped make coverage more affordable.

The rising cost of health insurance and unfavorable regulatory changes have contributed to membership loss, with Centene’s Medicaid membership down 4% and the company’s ACA membership down 54%. Those losses are now spurring Centene to shrink its operations, with executives laser-focused on improving margins.

Tennessee’s Freedom, Access and Integrity in Registered Pharmacy (FAIR Rx) Act prohibits PBMs, influential middlemen in the pharmaceutical supply chain, from owning pharmacies amid widespread worries that conglomerates that operate both businesses are leaning on that market power to drive independent pharmacies out of business. The complaints against the FAIR Rx act attack the legislation as a thinly veiled attempt to constrain legal competition against Tennessee’s independent pharmacies and argue it violates the Constitution’s Dormant Commerce Clause by discriminating against an out-of-state business.

The CMS has proposed updating its TAVR coverage policy to expand access beyond symptomatic patients to include people with asymptomatic severe aortic stenosis, reflecting newer evidence and prior FDA label expansion for the Sapien 3 device. The proposal removes some prior restrictions and is viewed positively for Edwards Lifesciences though analysts note requiring follow-up study participation could slow uptake; the public comment period is open before a final decision expected in September.